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Medicare Advantage Benefits at a Glance

2019 MEDICARE ADVANTAGE PLANS

Benefits at a Glance

The following is intended to be only a summary of benefits for Generations Medicare Advantage plans. For a complete list, including any limitations, exclusions, and plan restrictions, please review the GlobalHealthSummary of Benefitsfor Generations Medicare Advantage plans.

Your costs will be no more than 37% of the cost for genericdrugs. You pay 25% of the cost of brand name drugs.

Catastrophic Coverage Stage After you have paid $5,100 out-of-pocket

You pay the greater of 5% of the cost of the drug or $3.40for generics/$8.50 for brandnames.

Gap Coverage

You pay the same cost sharing for Tier 6 drugs that you paid in the Initial Coverage Stage, whichever is less, and the plan pays the rest.

GENERATIONS SELECT (HMO)

Drug Type

30-Day Supply at Preferred Retail Pharmacy

90-Day Supply from Mail Order Pharmacy†

30-Day Supply from Standard Retail Pharmacy

Tier 1 - Preferred Generics

$5

$0

$10

Tier 2 - Generics

$15

$30

$20

Tier 3 - Preferred Brand Name

$42

$84

$47

Tier 4 - Non-Preferred

40%

30%

50%

Tier 5 - Specialty

33%

N/A

33%

Coverage Gap Stage After your prescription costs reach $3,820

Your costs will be no more than 37% of the cost for genericdrugs. You pay 25% of the cost of brand name drugs.

Catastrophic Coverage Stage After you have paid $5,100 out-of-pocket

You pay the greater of 5% of the cost of the drug or $3.40 for generics/$8.50 for brand names.

Gap Coverage

You pay the same cost sharing for Tier 1 drugs that you paid in the Initial Coverage Stage,whichever is less, and the plan pays the rest.

PLEASE NOTE: Generations Classic and Generations Select have different drug formularies. Please visit our website for the most up-to-date drug formularies. The formulary and/or pharmacy network may change at any time. You will receive noticewhen necessary.

† Costs for 90-day supply are higher at Standard Retail Pharmacy

Additional Benefits Not Covered Under Original Medicare

Generations Value

Podiatry Services – Foot Care

$40 copay (covered under Original Medicare)

Routine Vision Exam

You pay nothing for up to 1 visit per year

Routine Eyewear Benefit

$50 copay; plan pays up to a $200 calendar year maximum

Dental

You pay nothing for preventive services

Over-the-Counter Benefit

$50 quarterly benefit for over-the-counter (OTC) health and wellness products available through our mail order service. If $50 is not used in a quarter, the balance does not carry over. Prices include shipping, handling, and sales tax.

$30 quarterly benefit for over-the-counter (OTC) health andwellness products available through our mail order service. If$30 is not used in a quarter, the balance does not carry over.Prices include shipping, handling, and sales tax.

$30 quarterly benefit for over-the-counter (OTC) health andwellness products available through our mail order service. If$30 is not used in a quarter, the balance does not carry over.Prices include shipping, handling, and sales tax.

Fitness Benefit

You pay nothing at an in-network fitness facility

* Our plan covers many preventive services, including:

Abdominal aortic aneurysm screening

Alcohol misuse counseling

Bone mass measurement

Breast cancer screening (mammogram)

Cardiovascular disease (behavioral therapy)

Cardiovascular screenings

Cervical and vaginal cancer screening

Colonoscopy

Colorectal cancer screenings

Depression screening

Diabetes screenings

Fecal occult blood test

Flexible sigmoidoscopy

HIV screening

Medical nutrition therapy services

Obesity screening and counseling

Prostate cancer screenings (PSA)

Sexually transmitted infections screening and counseling

Tobacco use cessation counseling (counseling for people with no sign of tobacco-related disease)

Vaccines, including Flu shots, Hepatitis B shots, Pneumococcal shots

"Welcome to Medicare" preventive visit (one-time)

Yearly "Wellness" visit

Any additional preventive services approved by Medicare during the contract year will be covered.

2018 MEDICARE ADVANTAGE PLANS

Benefits at a Glance

The following is intended to be only a summary of benefits for Generations Medicare Advantage plans. For a complete list, including any limitations, exclusions, and plan restrictions, please review the GlobalHealthSummary of Benefitsfor Generations Medicare Advantage plans.

Your costs will be no more than 44% of the cost for generic drugs. You pay 35% of the cost of brand name drugs.

Catastrophic Coverage Stage After you have paid $5,000 out-of-pocket

You pay the greater of 5% of the cost of the drug or $3.35 for generics/ $8.35 for brand names.

Gap Coverage

You pay the same cost sharing for Tier 1 drugs that you paid in the Initial Coverage Stage or 44% of the cost, whichever is less, and the plan pays the rest.

PLEASE NOTE: Generations Classic and Generations Select have different drug formularies. Please visit our website for the most up-to-date drug formularies. The formulary and/or pharmacy network may change at any time. You will receive noticewhen necessary.

† Costs for 90-day supply are higher at Standard Retail Pharmacy

Additional Benefits Not Covered Under Original Medicare

Generations Value

Podiatry Services – Foot Care

$40 copay (covered under Original Medicare)

Routine Vision Exam

You pay nothing for up to 1 visit per year

Routine Eyewear Benefit

$50 copay; plan pays up to a $200 calendar year maximum

Dental

You pay nothing for preventive services

Over-the-Counter Benefit

$50 quarterly benefit for over-the-counter (OTC) health and wellness products available through our mail order service. If $50 is not used in a quarter, the balance does not carry over. Prices include shipping, handling, and sales tax.

Generations Classic

Podiatry Services – Foot Care

$40 copay (covered under Original Medicare)

Routine Vision Exam

You pay nothing for up to 1 visit per year

Routine Eyewear Benefit

$40 copay; plan pays up to a $200 calendar year maximum

Dental

You pay nothing for preventive services

Over-the-Counter Benefit

$50 quarterly benefit for over-the-counter (OTC) health andwellness products available through our mail order service. If$50 is not used in a quarter, the balance does not carry over.Prices include shipping, handling, and sales tax.

Generations Select

Podiatry Services – Foot Care

$25 copay (covered under original Medicare)

Routine Vision Exam

You pay nothing for up to 1 visit per year

Routine Eyewear Benefit

$35 copay for frames and lenses; Plan pays up to a $200 calendar year maximum

GlobalHealth is an HMO plan with a Medicare contract. Enrollment in GlobalHealth depends on contract renewal. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium. By calling the listed number you may be speaking to a licensed sales representative.